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Block 2 > Prev Med > Flashcards

Prev Med Flashcards

1
Q

Epidemiology

A

Studying distribution and determinants of dz freq in human pop

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2
Q

Key components of epi

A

Dz distribution (dz patterns), dz determinants (preventive or casual factors changing person’s health), dz control (surveillance)

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3
Q

Pop at risk

A

Specific pop of individuals truly capable of acquiring condition or event of interest. Pops can be classified as open/dynamic or closed/fixed

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4
Q

Closed pop/fixed cohort vs open pop/dynamic pop

A

Members of pop = constant vs members of pop changes (adding or losing members)

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5
Q

What is a sample?

A

Subset/group of pop to represent the entire pop

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6
Q

Rate vs proportion vs ratio

A

How fast; freq of event in a defined time; incidence, mortality rate vs how much; freq of event in defined pop; prevalence vs relationship b/w 2 groups and health income; odds ratio

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7
Q

diff b/w Rate vs risk

A

Estimates risk if event occurs once per person, proportion of event <5%, short time interval vs based on chance; the probability that an event will occur

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8
Q

how to find Measures of dz: counts vs proportions/prevalence vs rates/incidence

A

Measure of dz freq, number of cases or health outcomes being studied, no denominator vs # of dz cases in pop in specified time/ # of ppl in pop in specified time vs # of new dz cases in specified time/total # of ppl at risk in specified time

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9
Q

How to measure mortality rate vs infant mortality rate

A

of deaths in 1yr/# of persons in pop at mid year vs # of deaths under 1yo in specified time/# of live births in specified time

number of deaths in a year/# of ppl mid year vs # of deaths <1yo in a specified time/# of live births during that specified time

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10
Q

Attack rate

A

Similar to incidence, used when dz = observed for short time period like food outbreaks. # of new cases during specified time/total # of ppl at risk during specified time

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11
Q

Case fatality rate

A

Number of deaths d/t dz —> measures lethality. # of ppl dying of dz during specified time/total # of ppl w/ dz

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12
Q

Relationship b/w prevalence, incidence, duration

A

P = I x D

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13
Q

Primary vs secondary data sources

A

Orig research/findings/project, gathers new data not collected before (researchers collect data themselves) vs docs analyzing primary sources, gathers existing data (researchers don’t collect data)

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14
Q

Common sources for data collection

A

Surveys (pop based regionally or nat’lly), healthcare provider based (PE, EHR, clinical pop), registries (pt org, health ministry, public health), administrative data (enrollment/eligibility, claims)

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15
Q

2 examples of data collection methods

A

Counts (individuals tally dz or target info) or sampling (subset of reference pop)

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16
Q

Impt considerations of health data

A

Objective, collecting procedures, data completeness, timing, type of data, size of sample, primary or secondary data

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17
Q

Strengths vs weaknesses of health data

A

Better surveillance, assess dz trends, allocate resources, develop health policy and scientific inquiry vs not all data = freely avail, time frame of data, incomplete data, different data collecting methods

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18
Q

Surveillance definition

A

Ongoing systematic collection, analysis, interpretation, dissemination of health data to plan, implement, and eval public health

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19
Q

4 types of surveillance: active vs passive vs syndromic vs sentinel

A

Health depts collect info from labs, drs, healthcare; complete and accurate reports vs labs, drs, healthcare report to health depts; case reports based on standard case definition; deaths reported on standard certificate vs using health data to ID dz clusters early before dx and report to health depts; uses “real time” vs collecting and analyzing data by designating institutions for their location or specialty —> dx and report high quality data

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20
Q

Types of research

A

Bench science, clinical, primary care, pharmaceutical, public health

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21
Q

Purpose of research

A

Advance sci knowledge using scientific method: lit review, follow protocol, have research question, test/analyze, share results

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22
Q

Community Health Assessments (CHA)

A

ongoing process of ID health status, needs, assets of a community —> find opportunities and priorities to improve; requirement for tax-exempt hospitals and gov’t health; don’t follow scientific method but does follow standardized protocol and have goals

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23
Q

Main challenge of health data overload

A

No quantity but quality: which data is useful?

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24
Q

Use of surveillance

A

Estimate magnitude of problem; determine geo dz distribution, dz hx, epidemics, changes in health practices; make hypotheses to do research; eval control measures; facilitate planning

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25
Q

observational studies

A

study wider range of exposure than experimental studies; studies causes, tx, prevention

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26
Q

2 types of observational studies: descriptive vs analytical

A

when little info is known about dz –> find potential associations (hypothesis); objective = estimate dz freq; variables examined = person, place, time (who/where/when = affected?) vs when enough info of dz = done –> answers “why”/cause of associations and additional questions about dz –> new data (why/how pop = affected?)

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27
Q

types of descriptive studies from least evident to most evident

A

case report/series, cross sectional studies, ecological studies

28
Q

case report vs series

A

single occurrence of incident, reports new/unique findings (new dz, adverse rxn, possible link b/w exposure, tx outcome) vs report on characteristics of a group of ppl w/ certain dz, no comparison group –> just look at 1 group; can also be based on 1 person

29
Q

advantages vs disadvantages of case report/series

A

ID new clinical issues that lead to hypothesis, educational vs depends on avail and accuracy of data; cases = not generalizable; not based on systemic studies; no comparison group; can’t make tx decisions

30
Q

cross sectional study

A

exposure and dz status w/in well defined pop = measured at one point in time –> one time assessment (surveys/questionnaire, lab tests, physicals); compare dz prevalence b/w those exposed and not exposed

31
Q

advantages vs disadvantages of cross sectional study

A

cheap and quick to conduct, outcomes and risk factors = assessed, good generalizability vs difficult to determine temporal relationship b/w exposure and dz, may have high prevalence from long duration cases

32
Q

how to ID cross sectional study?

A

look for one time frame, no f/u, no intervention, only analyze prevalence, can ID risk factors and dz they studied

33
Q

ecological study

A

studying freq of characteristic and outcome in a pop, not individual or location; often uses scatter plots or Pearson correlation coefficients

34
Q

advantages vs disadvantages of ecological study

A

easy to do at global lvl –> give quick answers to group phenomena vs ecological fallacy –> apply findings of pop to individual

35
Q

types of analytical studies from least evident to most evident

A

case control studies, cohort studies

36
Q

case control studies vs cohort studies

A

examine groups based on dz status (dz’ed vs control group) –> follow those 2 groups –> past exposures determined in each group; uses indirect measure of risk –> no incidence measured –> use odds ratio vs examine groups w/ or w/o specific exposure in pop w/o disease at beginning of study

37
Q

advantages vs disadvantages of case control studies

A

good for rare dzs or that have long indux and latent periods; can eval mult exposures, quick and cheap, small sample size = okay vs investigates only 1 dz outcome, not good for rare exposures, can’t directly determine incidence rates or temporal relationship b/w exposure and dz, vulnerable to bias b/c retrospective (recall bias)

38
Q

case vs control in case control studies

A

sample should reflect all cases in one pop, should not be selected b/c of exposure vs comparable to cases in every way except they don’t have dz –> must be chosen independent of exposure

39
Q

retrospective vs prospective cohort studies

A

examine cohorts from the past to present; cheaper, faster, good for dzs w/ latent period, past exposure data = inadequate vs examine cohorts from the present to future; more expensive, slower, not good for dzs w/ latent period, better exposure data, less bias

40
Q

how to find good sample size for cohort?

A

based on exposure status and follow them, pick a well defined pop –> do questionnaires, lab tests, physicals, procedures, existing records to gather data

41
Q

advantages vs disadvantages of cohort studies

A

directly determines incidence and risk, relationship b/w exposure and dz (better if exposure = rare), follows logic of clinical question, vs needs large sample size, long time to complete, not good for rare dzs, expensive, validity affected by bias d/t subject attrition and loss to f/u

42
Q

nonrandomized experimental study: quasi experimental study

A

study pop –> current tx (control) or new tx (experimental) –> improve or not improve for both

43
Q

randomized study: random controlled trials

A

researcher takes large sample size and uses random assignment to divide them into smaller groups, subjects = blinded to their group membership –> 1 group w/ real med, other group w/ placebo

44
Q

equipoise

A

randomization = ethical when no compelling reason to believe either of randomly allocated txs = better than the other

45
Q

types of experimental studies: preventive vs therapeutic vs individual vs community vs cross over vs parallel vs simple vs factorial

A

investigating a measure that prevents dz vs investigating a measure that tx dz vs tx given to individual vs tx given to group vs planned reversal of experimental and control group throughout trial –> each person has own control vs everyone has same study tx vs each group has tx consisting of one component vs each group has tx consisting of 2+ components –> answers more research questions

46
Q

overall conduct of experimental studies

A

Hypothesis → participant recruitment → participants allocated to groups → participants’ outcome mentored → rates of outcomes are compared → conclusions and implications

47
Q

absolute risk

A

risk of developing dz over time; same as incidence

48
Q

measures of association/effect

A

measures b/w exposure and dz that are compared to risk –> represent diff concepts of risk or diff magnitude of risk

49
Q

attributable risk. =0 vs <0 vs >0

A

diff in risk b/w exposed and unexposed group: incidence in exposed minus incidence in unexposed; also use 2x2 table. exposure = NOT assoc w/ dz vs dec in dz risk –> protective vs inc in dz risk –> harmful

50
Q

relative risk. =1 vs >1 vs <1

A

compares incidence in exposed to unexposed –> incidence in exposed/incidence in unexposed; also use 2x2 table. exposure NOT assoc w/ dz vs exposure assoc w/ inc risk of dz vs exposure assoc w/ dec risk of dz

51
Q

odds ratio. =1 vs >1 vs <1

A

compares odds of case being exposed to odds of control being exposed –> odds case exposed/odds control exposed. dz = NOT assoc w/ exposure vs exposure –> inc odds of dz vs exposure –> dec odds of dz

52
Q

absolute risk reduction vs relative risk reduction

A

excess risk assoc w/ exposure compared to control vs how much risk = reduced in experimental group to control group

53
Q

allocation concealment vs triple blind

A

investigators won’t know which tx groups will receive vs participants, investigators, analysts don’t know GROUP MEMBERSHIP

54
Q

intention to tx vs per protocol

A

how well the intervention worked between assigned groups, irrespective of participant adherence to control/intervention vs compares outcomes of those who did or did not receive treatment, regardless of assigned group (cross-over); loss of randomization

55
Q

comparison groups: control vs usual vs placebo/sham

A

no intervention; Hawthorne effect - pts have tendency to change behavior when they are target of interest vs compares expt’l tx to known tx vs compares expt’l tx to placebo

56
Q

noncompliance in random controlled trials: loss to f/u or overt noncompliance vs covert noncompliance vs contamination

A

officially notifies investigators and drops out of study vs participant stops or modifies assigned treatment without notifying investigators –> do compliance checks to elim vs control group does intervention

57
Q

Number needed to treat (NNT) vs Number needed to harm (NNH)

A

number of patients needed to treat to prevent one patient from having an adverse event over a predefined period of time vs number of patients needed treat for one patient to experience an adverse event.

58
Q

systematic review vs meta analyses

A

qualitatively answer a single, focused question by summarizing original research vs use statistical methods to combine results of individual studies and provide a quantitative answer within the context of a systematic review; includes insignificant data

59
Q

strengths vs weaknesses for systematic review

A

answers single focused question, qualitative vs publication bias –> excludes nonsignificant findings, unpublished data, grey literature/ fugitive literature, disagreement on findings

60
Q

strengths vs weaknesses for meta analyses

A

adeq sample size/power, detect tx complications and effectiveness, quantitative vs publication bias, few studies –> high risk of false neg; doesn’t include biology of disease or clinical experience

61
Q

fixed effects vs random effects model

A

studies answer the same question –> answers may differ by only chance vs studies answer diff questions but form a fam of studies answer similar question; studies = considered a random sample

62
Q

Forest plot

A

Shows the point estimate of effectiveness and confidence interval for each study in the review; values to left of null line –> favor expt’l group, values to right of null line –> favor control group

63
Q

PRISMA checklist

A

minimum set of items for reporting in systematic reviews and meta-analyses

64
Q

How to fix publication bias?

A

Encourage releasing all results, registration for all clinical trials, Cochran collaborators. Funnel plots can assess the bias

65
Q

PICO

A

Pt, intervention, comparison (other tx, placebo), outcome

66
Q

which measure of association would you use for cohort vs case control vs expt’l design?

A

relative risk, attributable risk vs odds ratio vs NNT, NNH, ARR, RRR

67
Q

what is CONSORT criteria used for?

A

reporting results: consolidated standards of reporting trials

Block 2 (16 decks)

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